Autism

What is autism?

Autism is a disorder in which children have problems with language and getting along with others. They have unusual, repetitive, or severely limited activities or interests. In every 1000 children, about 3 to 6 have autism. Boys are 4 times more likely to have autism than girls.

There is a wide range of symptoms and abilities. A child with autism can be very high-functioning or very severe. Autism is the most common disorder in a group of conditions called autistic spectrum disorders (ASD), also called Pervasive Developmental Disorders (PDD).

What is the cause?

In autism there is a problem in the brain. Brain scans show that the structure or shape of the brain is different in children with autism. The cause is still not known. There are many possible causes.

Autism and similar disorders sometimes run in families. There may be certain genes linked to autism. Researchers are also studying if a problem during pregnancy or environmental factors, such as exposure to chemicals, may be a cause.

Children with other brain problems and genetic syndromes such as congenital rubella syndrome, neurofibromatosis, and fragile X syndrome, are sometimes also autistic.

What are the symptoms?

Children with autism may appear normal for the first few months of life. Your child may then become more and more unresponsive to you. Many parents first notice a problem when their child does not develop language skills like other children of the same age. Your child may have a number of symptoms in the following areas listed below (depending on age). Symptoms usually appear by the age of 3 years. No child with autism will have all of the symptoms listed below and they may have some symptoms that are not on this list.

• Social skills: Your child may resist being cuddled and may scream to be put down when held. He may withdraw from you and fail to form relationships. You may notice that he avoids eye-to-eye contact and prefers to play alone. Your child may be indifferent to the feelings of others and to social norms.
• Language and imagination: An autistic child usually speaks later than other children of the same age. He often cannot understand or copy speech or gestures. The rate, pitch, tone, or rhythm of speech is abnormal. Your child will probably be unable to start a conversation or keep one going and respond inappropriately to sounds. His speech will be immature and unimaginative. He may just make up words or echo what someone says. Your child will probably be unable to engage in fantasy or imaginative play such as role playing and storytelling.
• Behavior, activities, and interests: Autistic children develop strong habits and compulsive routines. They might spend hours lining up their cars and trains in a certain way, rather than using them for pretend play. If someone accidentally moves one of the toys, they may get very upset. It is also hard for them to change their routine. Your child may be obsessed with one topic or idea and may become attached to unusual objects. He may walk on tiptoe or flick or twiddle his fingers for long periods. He may even bang his head, rock, stare, or have sudden screaming spells. He may injure himself on purpose. Autistic children often have trouble learning manual tasks and are sometimes hyperactive. Some children develop seizures.
• Sensory problems: Autistic children may also have problems with their senses. Many are very sensitive to certain sounds, textures, tastes, and smells. Some children find the feel of clothes touching their skin almost unbearable. Some sounds, such as a vacuum cleaner, a ringing telephone, a sudden storm, even the sound of waves lapping the shoreline, will cause these children to cover their ears.

How is it diagnosed?

It is very difficult to diagnose autism when children are young. Some of the behaviors that your child's doctor will look for include:

• Does the child respond to his or her name when called? Children diagnosed with autism often fail to respond to their own name. They tend to turn and look at the person only about 20% of the time. They may fail to respond to their parent calling their name, but immediately respond to the television being turned on. It is not unusual for parents to suspect their child has a hearing loss.
• Does the child share? Children with autism rarely follow along with games, do not often shift their gaze back and forth from objects to people, and do not "show" toys to the parent.
• Does the child imitate others? Children with autism less often imitate others. They tend to avoid waving, making faces, or playing pat-a-cake.
• Does the child respond to others? Children with autism may seem unaware of the emotions of others. They may not look or smile in response to other's smiles. They also may ignore others who are upset or in pain.
• How does the child play? Children with autism may not be interested in toys at all, paying more attention to the movement of his hands, or a piece of string. If interested in toys, only certain ones may catch their interest. They may be more interested in turning a toy car upside down and spinning the wheels than pushing the car back and forth.

There may be a wide range in abilities because of the child's age and how severe the symptoms are.

Your child's doctor will probably do lab tests to rule out other medical problems. Your child will also have a hearing test. Because it can be inherited, your health care provider may want to screen your other children for symptoms.

What is the treatment?

The treatment of autistic children focuses on educational and behavioral therapy. Even very young children can benefit from language therapy and behavior programs.

By law, the public schools must prepare and carry out a teaching plan designed to help children in a special education program to reach instruction goals or learn specific skills. The list of skills is known as the child's Individualized Education Program (IEP). The IEP is an agreement between the school and the family about the child's goals. Parents play an important part in creating the program, since they know their child and his or her needs best.

Behavioral therapy can also be done by parents. The first step is to choose a skill to work on. You need to make sure the child can succeed. When children are successful, you reinforce them. When they are reinforced, they start to understand what you want them to do. A reinforcer follows a behavior and increases the chances that the behavior will be repeated. Be sure that the reinforcer you use is actually reinforcing to your child and that it works for the behavior you are trying to change. Some things that have been found to be reinforcing for children with autism are food, hugs, massage, being lifted or swung in the air, TV, videos, music, and reading books. It is also important to show your child that interacting with people is fun and that communicating with people leads to good things (reinforcers). For example, if you tell your child "touch your ear" and then guide his hand to his ear and instantly reinforce him with a big smile and hug, he might be more likely to touch his ear the next time someone says "touch your ear".

Sometimes medicine can help. Mood- or behavior-altering drugs can improve behaviors that may cause self-injury or greatly interfere with school or social ability. These medicines must be prescribed by a doctor experienced with their use in children with autism. There is no medicine that will take away the symptoms of autism.

Parents of children with autism often become aware of new or alternative treatments through friends or the media. Your provider can help you decide if these treatments could help or harm your child.

Where can my family get help and support?

When parents hear that their child has autism, they may feel fear, anger, guilt, and other difficult emotions. Many families find that seeing a mental health professional helps them to cope.

Children with autism can cause stress on the entire family. It can affect recreation and family finances. It can also strain your marriage and relationships between siblings.

You will probably want to explore community and government resources as well as local support groups. Support groups can help by sharing common concerns and solutions to problems with other families in the same situation. You can find these services through your health care provider, schools, therapy programs, and local and national support organizations.